Unit 8 Live Seminar 9:00pm(est) Professor: Dr. Chanadra Young Whiting Course: HS440 Finance for Healthcare Agenda äStart: Ice Breaker äDiscuss Unit 8 Readings: äReview: Units 8 and 9 Assignments äReview Units 8-10 on the Final Project ä Closing (Questions) Health Care Finance by Judith J. Baker and R.W. Baker. Copyright © 2006 by Jones and Bartlett Publishers, Inc. Chapter 13 Slide 1

Unit 8 Assignment OIG’s List of Excluded Entities -Search the OIG’s List of Excluded Entities website: for providers in the state where you live or work. - Submit written definitions or brief explanations for the 12 Key Terms for this unit.

Unit 8 Readings äStudents should peruse the OIG website, particularly the current year’s OIG Work Plan and latest news sections, to see the variety of issues the federal government is targeting with enforcement efforts against healthcare fraud and abuse. Health Care Finance by Judith J. Baker and R.W. Baker. Copyright © 2006 by Jones and Bartlett Publishers, Inc. Chapter 13 Slide 3

Unit 8 Key Terms 1) Anti-Kickback law 2) Bundling 3) Claim Denial 4) Correct Coding Initiative 5)EMTALA 6) False Claims Act 7) Local Coverage Decision (Determination) 8) Medically necessary 9) National Coverage Decision 10) Non-covered service 11) Recovery Audit Contractors 12)Stark law

Unit 9 Assignment: Development of Nuclear cardiac stress lab Choose and explain Five of the assumption items listed below that can be utilized to develop your own nuclear cardiac stress lab: äExample of Typical Income Statement Assumption Information Requirements: äWhat types of revenue? äHow many services will be offered to produce the revenue (by month)? äHow much labor will be required (FTEs)? äWhat will the labor cost? äHow many and what type of supplies, drugs, and/or devices will be required to offer the service? äWhat will the supplies, drugs, and/or devices cost? äHow much space will be required? äWhat will the required space occupancy cost? äIs special equipment required? If so, how much will it cost? äIs staff training required to use the special equipment? If so, how much time is required, and what will it cost? -

Unit 8 Health Care Finance by Judith J. Baker and R.W. Baker. Copyright © 2006 by Jones and Bartlett Publishers, Inc. Chapter 13 Slide 6

UNIT 9 äResearch the CMS website ( for coverage of cardiac CT angiography (CCTA) as a possible competitive diagnostic tool which could affect volumes of cardiac stress testing. Check for both a National Coverage Decision (NCD) and National Coverage Analysis (NCA). äSearch the Medicare Administrative Contractor (MAC) site for Maryland (home of CMS headquarters) ( for coverage rules for cardiac CT on a local basis. Health Care Finance by Judith J. Baker and R.W. Baker. Copyright © 2006 by Jones and Bartlett Publishers, Inc. Chapter 13 Slide 7

UNIT 10 äThe final step of the course-long project will be to develop a written (2- 3) page report for the fictional cardiology practice stating what is your business plan for Medicaid and Medicare (your business plan can include ways to mange Medicare and Medicaid, ways to cut cost, and ways to improve the quality of care).Your final report must consist of a title and reference page (Which is not included in the page count). Your paper must be 2 pages in length, font size 12, and font name: Times New Roman. Finally, please make sure you double space. äSubmit your business plan report and your completed project spreadsheet in unit 10 final project dropbox. Health Care Finance by Judith J. Baker and R.W. Baker. Copyright © 2006 by Jones and Bartlett Publishers, Inc. Chapter 13 Slide 8